Patricia A. Treadwell, M.D. Professor of Pediatrics

Transcription

1 EXANTHEMS Patricia A. Treadwell, M.D. Professor of Pediatrics Indiana University School of Medicine

2 FACULTY DISCLOSURE I have the following financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity. :Investigator- Novartis I do intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

3 HAND-FOOT-AND-MOUTH DISEASE HFMD Usually occurs in children less than 10 years of age Fever

4 HFMD Classically Coxsackie virus A16 Human Enterovirus 71 Coxsackie virus A10, or A5 Other Coxsackie viruses Typically incubation is 3-6 6days Dyer JA. Pediatr Ann 2007;36:21-29.

5 HFMD - exanthem Vesicular eruption Lesions often on lateral fingers and toes- with an elliptical i l shape Erythematous surround May be particularly localized to areas of inflammation

6 HFMD - enanthem Vesicles in the oral cavity rupture to become ulcers Most commonly on the lateral l aspects of the tongue

7 HFMD - treatment Encourage fluid intake Fever control Analgesics

8 VARICELLA Varicella-Zoster virus Prodrome of fever, headache and malaise Highly contagious Incubation day range

9 VARICELLA - exanthem Tear drop shaped vesicles on an erythematous base Dew-drop on a rose petal The lesions spread from the trunk to the extremities Lesions progress to pustules and later p g p crusted lesions

10 VARICELLA - enanthem Vesicular lesions occur which may become pustular Vesicles which h rupture may become ulcers

11 VARICELLA - treatment Monitor fluid intake Reduce fever Antihistamines Antivirals especially if immunocompromised Role of vaccine to prevent disease Mann M, et al: Pediatrics 2008;122:e

12 SCARLET FEVER Streptococcus pyogenes Erythrogenic toxin Pharyngitis and eruption Fever Incubation 2-5 days

13 SCARLET FEVER - exanthem Erythema accentuated in fold areas Pastia s sign Sand-paper type eruption Desquamation

14 SCARLET FEVER - enanthem Erythematous oropharynx Exudates (Cervical lymphadenopathy) Petechiae of soft palate Strawberry tongue

15 SCARLET FEVER - treatment Monitor fluid intake Reduce fever Analgesics Penicillin Clindamycin Erythromycin

16 UNILATERAL LATEROTHORACIC EXANTHEM Unilateral laterothoracic exanthem A.K.A. Asymmetrical periflexural exanthem of childhood d Described in 1962 Usually in children, reports in adults are rare

17 UNILATERAL LATEROTHORACIC EXANTHEM Eczematous papules of unilateral axilla and flank Then spread to other areas of body Unusual viral exanthem-reported associated with parvovirus B19 and Epstein Barr virus along with others

18 UNILATERAL LATEROTHORACIC EXANTHEM Topical corticosteroids for inflammation Antipruritics for itching

19 REFERENCES Chuh AA, et al: Unilateral mediothoracic exanthem: a variant of unilaterothoracic exanthem. Cutis 2006;77: Scheinfeld N: Unilateral laterothoracic exanthema with coincident id evidence of Epstein Barr virus reactivation: Exploration of a possible link. Dermatol Online J 2007;13:13.

20 GIANOTTI-CROSTI SYNDROME Associated with viral illness Virus-associated exanthem Most often in children aged 2-6 years of age Generalized lymphadenopathy may be seen Infrequently pruritic May last 6-8 weeks

21 GIANOTTI-CROSTI SYNDROME Clinical findings: -Papular lesions -Urticarial lesions -Less often, vesicular or papulovesicular -More concentrated on the arms and legs -Can be seen on the trunk, but less dense -Koebner phenomenon

22 GIANOTTI-CROSTI SYNDROME Viruses associated with Gianotti-Crosti -Epstein-Barr -Hepatitis A,C -Cytomegalovirus -Human herpesvirus 6 -Coxsackievirus A16,B4, B5 -Rotavirus -Parvovirus B19

23 GIANOTTI-CROSTI SYNDROME Viruses associated with Gianotti-Crosti syndrome-continued -RSV -Echovirus -Enterovirus -Rubella and Mumps virus -Parainfluenza virus -HIV

24 GIANOTTI-CROSTI SYNDROME Bacteria associated with Gianotti-Crosti syndrome -Bartonella henselae -Beta-hemolytic streptococci -Borrelia Burgdorferi -Mycoplasma pneumoniae Gianotti-Crosti syndrome has been reported follwing some immunizations, however is not a contraindication to giving those immunizations

25 GIANOTTI-CROSTI SYNDROME -Treatment Topical corticosteroids (one report of worsening- does not pose a contraindication) Oral antihistamines if patient has pruritus.

26 GIANOTTI-CROSTI SYNDROME- References Fastenberg M, et al: Acral Papules: Gianotti-Crosti Syndrome. Pediatr Ann 2007;36: Xia Y, et al: Pruritic Acral Rash in a Child. Gianotti-Crosti i i Syndrome. Am Fam Physician 2008;78:

27 MEASLES (RUBEOLA) Caused by a paramyxovirus, an RNA virus Highly contagious prior to the use of the vaccine Uncommon with widespread use of the vaccine Prodrome of cough, coryza, conjunctivitis and Koplik s spots Fever Incubation days

28 MEASLES - exanthem A maculopapular eruption beginning at the scalp line->hairline->forehead-> retroauricular->face, neck->then spreading downward Fd Fades over a 72h hour period id Brownish discoloration noted after fading

29 MEASLES - enanthem Koplik s spots -white or bluish-gray specks -1mminsize -typically on buccal mucosa opposite lower molars May see erythematous papules on the palate Posterior pharynx often erythematous

30 MEASLES - treatment Monitor fluid intake Monitor respiratory status Rd Reduce fever Vitamin A in children 6 months to 2 years and dthose who have an immunodeficiency i 2006 Red Book. AAP Committee on Infectious Disease

31 INFECTIOUS MONONUCLEOSIS Epstein-Barr virus Prodrome of headache, malaise, fever and pharyngitis i Incubation days Exanthem occurs in 35% patients Accompanying Strep pharyngitis in 20-25% 25%

32 INFECTIOUS MONONUCLEOSIS - exanthem Erythematous maculopapular lesions Initially on the trunk and then spreads Areas of confluence can occur Pruritus Fd Fades in 34d 3-4 days Ellen Rimsza, M, et al: Pediatr Clin North Am 2005;52:9-24.

33 INFECTIOUS MONONUCLEOSIS - enanthem Macules or petechiae of the palate Erythema of the oropharynx Findings of Strep pharyngitis when present

34 INFECTIOUS MONONUCLEOSIS - treatment Monitor fluid intake Reduce fever Analgesics If Strep pharyngitis is present, pp y g p, treat with appropriate antibiotics

35 ROCKY MOUNTAIN SPOTTED FEVER Caused by Rickettsia i rickettsii ii Typically history of tick exposure Incubation 2-14 days

36 ROCKY MOUNTAIN SPOTTED FEVER Fever Severe headache Confusion Nausea and vomiting Photophobia

37 ROCKY MOUNTAIN SPOTTED FEVER - exanthem Exanthem present in 90 % patients Erythematous macules and papules initially Later, petechial or purpuric lesions Lesions occur initially on the palms and soles, then spread centrally

38 ROCKY MOUNTAIN SPOTTED FEVER Supportive therapy may be necessary Doxycycline Chloramphenicol

39 ROCKY MOUNTAIN SPOTTED FEVER-ReferencesReferences Chen LF, et al: What s New in Rocky Mountain Spotted Fever? Infect Dis Clin North Am 2008;22: Flicek BF. Rickettsial and Other Tick- Borne Infections. Ci Crit Care Nurs Clin North Am 2007;19:27-38.